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Review Series - Rationale and Practical Method for Lifestyle Modification

Practical and personal education of dietary therapy in hypertensive patients

Abstract

The guidelines for the management of hypertension by the Japanese Society of Hypertension (JSH2019) defined blood pressure (BP) levels of 130–139/80–89 mmHg as “elevated blood pressure”. The JSH2019 also revised the target level of BP control to a lower level. Thus, lifestyle modifications are quite important regardless of the use of antihypertensive drugs. Among the lifestyle modifications, salt reduction is most important, especially among East Asian people, who still consume a significant amount of salt. Since the awareness of salt reduction may not necessarily lead to actual salt reduction, the assessment of individual salt intake is essential when members of the medical staff provide practical guidance regarding salt reduction. The evaluation methods of salt intake are classified as the assessment of dietary contents and the measurement of urinary sodium (Na) excretion. Since highly reliable methods, such as the measurement of 24-h urinary Na excretion, are not convenient in practical clinical settings, the combination of the assessment of dietary contents using questionnaires and the estimation of salt intake using spot urine is recommended as a practical evaluation procedure. Repeated assessment of salt intake and practical guidance from dieticians are useful for long-term adherence to salt reduction. The Japanese Society of Hypertension Salt Reduction Committee began to certify flavorful foods as being low in salt content in 2013. More than 200 products have been certified as of April 2019. The utilization of these products is expected to aid in the salt reduction of hypertensive individuals as well as the Japanese general population.

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References

  1. The Writing Committee of the Japanese Society of Hypertension (eds). Guidelines for the Management of Hypertension 2019 (JSH2019). Tokyo: Life Science Publishing Co., Ltd.; 2019, p. 64–75.

  2. INTERSALT Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. Br Med J. 1988;297:319–28.

    Article  Google Scholar 

  3. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE.Global Burden of Diseases Nutrition and Chronic Diseases Expert Group et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371:624–34.

    Article  Google Scholar 

  4. He FJ, Macgregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009;23:363–84.

    Article  CAS  Google Scholar 

  5. Graudal N, Hubeck-Graudal T, Jurgens G, McCarron DA. The significance of duration and amount of sodium reduction intervention in normotensive and hypertensive individuals: a meta-analysis. Adv Nutr. 2015;6:169–77.

    Article  CAS  Google Scholar 

  6. He FJ, Li J, MacGregor GA. Effect of longer-term modest salt reductions on blood pressure. Cochrane Database Syst Rev. 2013;30:CD004937.

  7. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. Br Med J. 2013;346:f1326.

    Article  Google Scholar 

  8. Lennon SL, DellaValle DM, Rodder SG, Prest M, Sinley RC, Hoy MK, et al. 2015 Evidence analysis library evidence-based nutrition practice guideline for the management of hypertension in adults. J Acad Nutr Diet. 2017;117:1445–58.

    Article  Google Scholar 

  9. Mente A, O’Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M.PURE, EPIDREAM and ONTARGET/TRANSCEND Investigators et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet. 2010;388:465–75.

    Article  Google Scholar 

  10. Cook NR, Appel LJ, Whelton PK. Sodium intake and all-cause mortality over 20 years in the trials of hypertension prevention. J Am Coll Cardiol. 2016;68:1609–17.

    Article  CAS  Google Scholar 

  11. O’Donnell MJ, Mente A, Smyth A, Yusuf S. Salt intake and cardiovascular disease: why are the data inconsistent? Eur Heart J. 2013;34:1034–40.

    Article  Google Scholar 

  12. He FJ, Campbell NRC, Ma Y, MacGregor GA, Cogswell ME, Cook NR. Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health. Int J Epidemiol. 2018;47:1784–95.

    Article  Google Scholar 

  13. Liu H, Gao X, Zhou L, Wu Y, Li Y, Mai J, et al. Urinary sodium excretion and risk of cardiovascular disease in the Chinese population: a prospective study. Hypertens Res. 2018;41:849–55.

    Article  CAS  Google Scholar 

  14. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115.

    CAS  PubMed  Google Scholar 

  15. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M.ESC Scientific Document Group et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  16. WHO. Guideline: sodium intake for adults and children. Geneva, Switzerland: World Health Organization (WHO); 2012.

  17. Poorolajal J, Zeraati F, Soltanian AR, Sheikh V, Hooshmand E, Maleki A, et al. Oral potassium supplementation for management of essential hypertension: a meta-analysis of randomized controlled trials. PLoS ONE. 2017;12:e0174967.

    Article  Google Scholar 

  18. Vinceti M, Filippini T, Crippa A, de Sesmaisons A, Wise LA, Orsini N. Meta-analysis of potassium intake and the risk of stroke. J Am Heart Assoc. 2016;5:e004210.

    Article  Google Scholar 

  19. The Ministry of Health, Labour, and Welfare. The results of the 2017 National Health and Nutrition Survey in Japan. https://www.mhlw.go.jp/content/10904750/000351576.pdf.

  20. The Ministry of Health, Labour and Welfare. Dietary reference intakes for Japanese (2015). https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/eiyou/syokuji_kij.

  21. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336:1117–24.

    Article  CAS  Google Scholar 

  22. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D.DASH Sodium Collaborative Research Group et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344:3–10.

    Article  CAS  Google Scholar 

  23. Ndanuko RN, Tapsell LC, Charlton KE, Neale EP, Batterham MJ. Dietary patterns and blood pressure in adults: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr. 2016;7:76–89.

    Article  CAS  Google Scholar 

  24. Ohta Y, Tsuchihashi T, Ueno M, Kajioka T, Onaka U, Tominaga M, et al. Relationship between the awareness of salt restriction and the actual salt intake in hypertensive patients. Hypertens Res. 2004;27:243–6.

    Article  Google Scholar 

  25. Tsuchihashi T, Kai H, Kusaka M, Kawamura M, Matsuura H, Miura K. et al. Report of the Salt Reduction Committee of the Japanese Society of Hypertension (3) Assessment and application of salt intake in the management of hypertension. Hypertens Res. 2012;2012:p39–50. The Salt Reduction Committee of the Japanese Society of Hypertension.

    Google Scholar 

  26. Yamasue K, Tochikubo O, Kono E, Maeda H. Self-monitoring of home blood pressure with estimation of daily salt intake using a new electrical device. J Hum Hypertens. 2006;20:593–8.

    Article  CAS  Google Scholar 

  27. Ohta Y, Tsuchihashi T, Miyata E, Onaka U. Usefulness of self-monitoring of urinary salt excretion in hypertensive patients. Clin Exp Hypertens. 2009;31:690–7.

    Article  CAS  Google Scholar 

  28. Takada T, Imamoto M, Sasaki S, Azuma T, Miyashita J, Hayashi M, et al. Effects of self-monitoring of daily salt intake estimated by a simple electrical device for salt reduction: a cluster randomized trial. Hypertens Res. 2018;41:524–30.

    Article  CAS  Google Scholar 

  29. Kawasaki T, Itoh K, Uezono K, Sasaki H. A simple method for estimating 24 h urinary sodium and potassium excretion from second morning voiding urine specimen in adults. Clin Exp Pharm Physiol. 1993;20:7–14.

    Article  CAS  Google Scholar 

  30. Tanaka T, Okamura T, Miura K, Kadowaki T, Ueshima H, Nakagawa H, et al. A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen. J Hum Hypertens. 2002;16:97–103.

    Article  CAS  Google Scholar 

  31. Takimoto H, Saito A, Htun NC, Abe K. Food items contributing to high dietary salt intake among Japanese adults in the 2012 National Health and Nutrition Survey. Hypertens Res. 2018;41:209–12.

    Article  Google Scholar 

  32. Kobayashi S, Murakami K, Sasaki S, Okubo H, Hirota N, Notsu A, et al. Comparison of relative validity of food group intakes estimated by comprehensive and brief-type self-administered diet history questionnaires against 16 d dietary records in Japanese adults. Public Health Nutr. 2011;14:1200–11.

    Article  Google Scholar 

  33. Kobayashi S, Honda S, Murakami K, Sasaki S, Okubo H, Hirota N, et al. Both comprehensive and brief self-administered diet history questionnaires satisfactorily rank nutrient intakes in Japanese adults. J Epidemiol. 2012;22:151–9.

    Article  Google Scholar 

  34. Sakata S, Tsuchihashi T, Ohta Y, Tominaga M, Arakawa K, Sakaki M, et al. Relationship between salt intake as estimated by a brief self-administered diet-history questionnaire (BDHQ) and 24-h urinary salt excretion in hypertensive patients. Hypertens Res. 2015;38:560–3.

    Article  CAS  Google Scholar 

  35. Yasutake K, Miyoshi E, Kajiyama T, Umeki Y, Misumi Y, Horita N, et al. Comparison of a salt check sheet with 24-h urinary salt excretion measurement in local residents. Hypertens Res. 2016;39:879–85.

    Article  CAS  Google Scholar 

  36. Ohta Y, Tsuchihashi T, Onaka U, Miyata E. Long-term compliance of salt restriction and blood pressure control status in hypertensive outpatients. Clin Exp Hypertens. 2010;32:234–8.

    Article  CAS  Google Scholar 

  37. The Japanese Society of Hypertension. Starting a low sodium diet—information from the Salt Reduction Committee to general public. http://jpnsh.jp/general_salt.html.

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Correspondence to Takuya Tsuchihashi.

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Tsuchihashi, T. Practical and personal education of dietary therapy in hypertensive patients. Hypertens Res 43, 6–12 (2020). https://doi.org/10.1038/s41440-019-0340-5

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